OSFI-590 (2007 Long Form Version)
PROTECTED
WHEN
COMPLETED AND
FILED WITH OSFI
(Report under subsection 11(2) of the Regulations Implementing the
United Nations Resolution on the Democratic People’s Republic of Korea or of the
WHEN COMPLETED
Regulations Implementing the United Nations Resolution on Iran)
The Long Form version can be used by financial institutions to file a POSITIVE Report only.
To file a NIL Report, please use the Short Form version of the OSFI-590.
REPORTING MONTH:
This report must be filed with the Office of the Superintendent of Financial Institutions,
Regulatory Information Division, 255 Albert Street, Ottawa Ontario K1A 0H2, or by fax at (613)
991-6248.
Name of Financial Institution:
Type of Financial Institution (check one):
 Bank
 Trust or Loan Company
 Insurance Company
 Fraternal Benefit Society
 Cooperative Credit Assoc.
 Foreign Bank Branch
Filing Options (check one):

FAX only

MAIL only

FAX and MAIL
613-991-6248
 Foreign Insurance Company
If this is a joint Report, insert the names of the other
Federally Regulated Financial Institutions (FRFI)
included in this Report (see Instruction 12):
Name of other FRFI(s):
Yes The above financial institution(s) have an account in the name of a Designated Person*, or have a contract with a Designated Person,
or possess or control property that is owned or controlled by or on behalf of a Designated Person.
Please complete the table below and the certificate at the end of this form.
2
Definitions:
 “No.” means “number”, and refers to the number of accounts, policies or contracts associated with a Designated Person.
 “Property” includes assets under administration (both discretionary and non-discretionary).
 “SRO” means Self Regulatory Organization.
 “Federally Regulated Financial Institution” means a Financial Institution that is regulated by OSFI.
* Please refer to # 4 of the “Instructions OSFI-590 Report” for the definition of “Designated Person”.
Type of Dealing with
Designated Person
Total Value of Dealing and Type of Entity Involved
Federally Regulated
Financial Institution
No.
$
Regulated Canadian
Financial Institution
Supervised by
Another Canadian
Regulator or SRO
Non-regulated
Canadian Entity
No.
No.
$
$
Total
Regulated Foreign
Financial Institution
Supervised by a
Foreign Regulator or
SRO
No.
$
Non-regulated
Foreign Entity
No.
$
No.
$
Property
Cash, cash equivalents, demand
and term deposits
Letters of credit, letters of guaranty
or similar obligations
Securities (bonds, debentures,
commercial paper, treasury bills,
mutual fund units, common and
preferred shares, and derivatives)
Life insurance and annuity
products with cash surrender
value (cash surrender value)
Other property, including real
estate
Totals
Loans
Mortgages, overdrafts, credit card
balances, term loans, lines of
credit balances, other
indebtedness
Insurance
Life insurance policies with no
cash surrender value (face value)
Annuity products with no cash
surrender value (monthly income)
OSFI-590
2007Version
3
Type of Dealing with
Designated Person
Total Value of Dealing and Type of Entity Involved
Federally Regulated
Financial Institution
No.
$
Regulated Canadian
Financial Institution
Supervised by
Another Canadian
Regulator or SRO
Non-regulated
Canadian Entity
No.
No.
$
$
Total
Regulated Foreign
Financial Institution
Supervised by a
Foreign Regulator or
SRO
No.
$
Non-regulated
Foreign Entity
No.
$
No.
$
Property & casualty insurance
policies (policy limit)
Group Benefit plans such as
medical or dental plans (policy
limit for Listed Person or Listed
Entity)
Certificate
The Undersigned certifies that, to the best of his/her knowledge, and after having made reasonable enquiries, the information contained in this Report
is correct, any property summarized in this Report has been frozen, and the relevant account details have been reported to the Royal Canadian
Mounted Police, the Canadian Security Intelligence Service and, in respect of any foreign operations, to foreign law enforcement officials, as
appropriate.
Name
Signature
Title
Telephone
Date
Reminder: Section 12 of the Regulations Implementing the United Nations Resolution on the Democratic People’s of Korea or of the Regulations
Implementing the United Nations Resolution on Iran requires every person in Canada and every Canadian outside Canada to disclose without delay
to the Royal Canadian Mounted Police and the Canadian Security Intelligence Service (a) the existence of property in their possession or control
that is owned or controlled by or on behalf of a Designated Person, and (b) information about a transaction or proposed transaction in respect of
property in their possession or control that is owned or controlled by or on behalf of a Designated Person.
OSFI-590
2007Version